AB0181 RADIOGRAPHIC DESTRUCTION OF CARPAL BONE IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS
Authors: R. Honma, Y. Takakubo, D. Saito, Y. Wanezaki, M. Aso, R. Monma, S. Yang, A. Sasaki, M. Takagi
Journal: Annals of the Rheumatic Diseases (2022)

Background The pharmacotherapy for rheumatoid arthritis (RA) has changed dramatically and caused a paradigm shift with the advent of methotrexate (MTX) and biological disease-modifying antirheumatic drugs (bDMARDs). Before the paradigm shift of RA therapy, the frequency of carpal collapse was high in patients with RA. It has been reported that certain numbers of patients with RA rapidly advance the destruction of the carpal bones during the early onset in the natural course of it [1]. Another report showed that hand function was positively correlated with disease activity[2] In Japan, bDMARDs were approved in 2003, and the maximum allowable dose of MTX was raised from 8 mg/week to 12 mg/week in 2012. We hypothesize early aggressive therapy for the patients with early RA may have improved outcomes of carpal bone destruction in this last decade. In this study, we investigated the change of drug therapy and carpal height ratio (CHR) in patients with early RA in the last decade. Objectives The aim of this study was to investigate CHR and drugs for the patients with early RA who developed it and started the therapy in 2009, 2014, and 2019. Methods Patients with early RA diagnosed in our department in 2009, 2014, and 2019 were included in the study. The CHR was measured at the first visit and two years later on radiographs of both hands. The drug history for RA was obtained in the medical records retrospectively. All statistical analyses were performed with EZR version 1.55. Results This study included 43 cases (36 females, 7 males). The number of cases in 2009, 2014, and 2019 was 16, 13, and 14, respectively. The mean age at the time of initial examination was 55 years (30-72). There was no significant difference in the mean value of DAS28-CRP at the time of the first visit in each year. The left hand CHR of initial diagnosis was 0.554 (0.484-0.632), 0.551 (0.490-0.618), and 0.567 (0.517-0.632) in 2009, 2014, and 2019, respectively, with no significant difference. Two years later, the left-hand CHR was 0.541 (0.475-0.651), 0.549 (0.502-0.617), and 0.562 (0.528-0.591), respectively, with no significant difference. There was also no significant difference in the amount of change. The right hand CHR of initial diagnosis was 0.525 (0.475-0.607), 0.539 (0.459-0.589), and 0.557 (0.506-0.635) in 2009, 2014, and 2019, respectively, with no significant difference. Two years later, the right-hand CHR was 0.532 (0.444-0.627), 0.529 (0.478-0.588), and 0.548 (0.491-0.593), respectively, with no significant difference. There was also no significant difference in the amount of change. The DAS28-CRP of initial diagnosis for cases in 2009, 2014, and 2019 was 4.68 (3.11-6.83), 4.19 (1.21-6.15), and 4.23 (2.41-6.38), respectively. The DAS28-CRP at 2 years after treatment for cases in 2009, 2014, and 2019 was 2.12 (0.96-3.60), 2.25 (1.13-4.81), and 2.04 (0.99-3.45), respectively. Although DAS28-CRP was improved, there was no significance among the three groups. The usage rate of MTX was 56.3% in 2009, 76.9% in 2014, and 50% in 2019, with mean doses of 6.2 mg (2-8 mg), 8.6 mg (4-12 mg), and 9.1 mg (4-16 mg), respectively. There was no significant difference in the rate and dosage of MTX use in each year. bDMARDs were used in one case in 2009, two cases in 2014, and one case in 2019. Conclusion In this study, DAS28-CRP showed a trend of improvement in this decade, but there was no obvious improvement in the progression of carpal collapse. Further early aggressive therapy may be necessary to prevent the destruction of the carpal bones. References [1]Ochi T, Iwase R, Yonemasu K, Matsukawa M, Yoneda M, Yukioka M, et al. Natural course of joint destruction and fluctuation of serum C1q levels in patients with rheumatoid arthritis. Arthritis and rheumatism. 1988 Jan; 31(1):37-43. [2]Palamar D, Er G, Terlemez R, Ustun I, Can G, Saridogan M. Disease activity, handgrip strengths, and hand dexterity in patients with rheumatoid arthritis. Clinical rheumatology. 2017; 36(10):2201-2208. Disclosure of Interests None declared